- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.61 / $589.61 / $2,525.00
| Facility | | $589.61 | $589.61 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,678.61 / $5,939.08 / $11,966.76
| Facility | | $2,678.61 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.16 / $2,037.71 / $4,901.97
| Facility | | $1,436.16 | $2,037.71 | $4,901.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.59 / $1,862.95 / $3,859.83
| Facility | | $1,305.59 | $1,862.95 | $3,859.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.82 / $1,116.20 / $3,991.00
| Facility | | $641.82 | $1,116.20 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $3,991.00 / $9,787.00
| Facility | | $2,740.00 | $3,991.00 | $9,787.00 |